HomeMy WebLinkAboutHomestead_Urbanek C. • STATE FORA.5356913/610) °
MEASURER FORM MIA
PPROVEDBY SATE BOARD OF ACCVINTS.3001 PRESCRIBED BY THE OkPARTMES1 OF LOCAL GOVERNMENT FINANCE IC 6-1.t-224l
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
411) benefit and to provide additional identifiing information necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
' PART 1: PROPERTY INFORMATION
Taxpayer Name Location Address
_ Weiss, Jan M
' 327 E 795 S/APACHE DRIVE
FORT BRANCH IN 47648
8153
Jan M Weiss iii0111-111/OII Inviii oii Inoil11011111011m 111 0111111 Li on II 0111EliII_II
327E 795 S
FORT BRANCH IN-47648,8009
IIIIIIIIIIIIIIIIII't110 111111111111111,11111111111.111111' State Parcel Number Legal Description
26-19-19-204-001.327-026/INDIAN HILLS 91 D-27
• This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
_ —
ch. _First Middle Last
JA-0 m. irlNe((e We s-S
Mailing Address(number and street,city.state,and ZIP code) ❑ Same as property address
3 l C -7 g S 5 L 4- /r/ 41:16
.
Spouse First Middle Last
9 a`e.2 i i-YA./� %74-,JCS
Mailing Address(Number and street,city,state,and ZIP code) are as property address
•
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she ii•y be liable fore back taxes and substantial financial penalties.
Owner 1 Signature L/`� ' Date /
�,.� ,. ,� �, _,�
eE ^'"�°, CLAIM FOR HOMESTEAD PROPERTY TAX � pjyY �ti =, `°�AR
;��� CREDIT/STANDARD DEDUCTION HCio
.�,,��� State Porm Sa73 (R2 / S92) ' 3� g s
�a.
INSTRUCTIONS: See reverse side lor7iling instructions.
�� �t. ir
� - � CERTIPICATION STATEMENT � • '
I�We) � v: `'} p1V?n xv �,D��—Y'� � certify that on ihe 1st day of March. 19
�) occupied as ourprincipal ��ce of residence the followi described real pwpeny for which a Homesiead Property Tax Credit is hereby daimed:
(We) owned ❑ Are buying under contract
Have a beneficial imerest in the entiry that is liable for ihe property taues on the property and ihat owns the property or is buying under a coniract.
. . CONTRACT RECORDED
II buying on coniraa, Pee Simple owner's name .. • - _ .
Recorders oHice where coniraci is recorded Record number Page
� PROPERTY DESCRIPTION
Couniy . Township - Tazing disirict (city, (own. township) '
Parcel number Legal deuription
' Q T
V
It any portion oi ihe residential stmcNre or ihe land mt exceeding one (1 � acre that immetliatety surmuntls that strucwre is used to produce income, describe the use and portion
of the pmperty utilized m protluce �ncome.
T.D. Y- 23-96 _
� 9-i - � �a�-
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
Counry Township County Township
�eby certify the above siatements are irue, correct and complete. Signa�ure f Uaimant
Address (numberandstreeG Gry, state, Z/PCOde) /
� �6
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�)
Otherland (z)
Total land (line 7 plus line 2� 3 i
l)
Dwelling (4) �
Residential improvemenis
Garage �5)
Other impmvements (6) �
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
1 hereby certify Ihe above i5 true, correti, and SgnaWre ot Assessor Dare signed
complete.
V�erityirg aciion - Signamre oi Autlitor ( Date signed
STANDARD DEDUCTION AILOWANCE
79_Pay19_
Lesser of 1/2 Homesiead
Valuation or 52.000
Dare signetl
5-